David Sanger, chief Washington correspondent for the New York Times, speaks in Rutland’s Paramount Theatre on Tuesday evening.

STAFF WRITER

The chief Washington correspondent for the New York Times said Tuesday that it could take experimentation on a national scale to devise a health care model that would be more affordable than the present system while still able to provide quality care.

David Sanger’s appearance before roughly 200 people at the Paramount Theatre in Rutland touched on a wide range of aspects confronting the Obama administration’s second term.

But the issue closest to the hearts of officials at Rutland Regional Medical Center, which hosted the event, is the future of health care.

“This is probably the most uncertain moment I have known in my career,” said Thomas Huebner, president and chief executive officer of RRMC.

With President Barack Obama’s re-election and the U.S. Supreme Court’s upholding this summer of the Patient Protection and Affordable Care Act, Huebner said big changes from the law and Vermont’s ongoing efforts to design a single-payer system lay ahead.

“If we continue in that direction will the federal waivers ever be granted? And is there the political will to put the tax structure in place necessary to pay for it? I don’t know,” Huebner told the audience before Sanger took the stage.

The one thing that Huebner said he could see with certainty is that the cost of health care will “drive everything” and that the “status quo is nowhere close to sustainable.”

Money will play a huge role, Sanger said, starting with the out-come of the so-called “fiscal cliff” the government will go over on Jan. 1 unless changes are made.

But further down the road, he predicted that the states would serve as laboratories for health care changes that could define the medical delivery and payment systems of the future.

“Some states will drag their feet and not set up the health care exchanges,” he said anticipating that state’s with Republican governors would resist implementing provisions of the new law. “But other states are going to experiment. I think we’re going to see a lot of experiments and eventually some will come out as models.”

In the more immediate future, the prospect of the “fiscal cliff” — shorthand for the date when terms of the Budget Control Act of 2011 are scheduled to go into effect and a number of tax cuts will end — stands to cost the hospital $5.4 million annually, Huebner said.

In his discussion about the fiscal cliff, Sanger didn’t predict an outcome but he said that the closer the country comes to Jan. 1, the more leverage the president has because of the unpopular prospect of an across the board end to popular tax cuts favored by Republicans.

“The president needs to convince the Republicans that he’s perfectly willing to drive over the cliff,” Sanger said. “It’s a giant game of chicken.”

But the senior correspondent said government actually has more wiggle room than the cliff analogy would imply.

While big fiscal changes would begin at the start of next month, he predicted that no long term consequences would be felt if divided lawmakers were able to reach a resolution within the first two weeks of the month.

Looking beyond the country’s borders, Sanger, who has written multiple books about America’s foreign policy, talked about the strengths and weaknesses of what he called Obama’s “light footprint” doctrine for foreign affairs.

In a seminal moment that defined the future policy for both Obamacare and the war in Afghanistan, Sanger described a 2009 meeting with his advisors weighing the cost and benefits of both campaigns.

“He got a plan from the Pentagon estimating that it would take 40,000 to 80,000 troops upwards of a decade to make (Afghanistan) stable,” he said. “When they told him it would cost roughly a trillion dollars, he said that’s roughly the cost of insuring every American over the same time period and that sort of decided the direction he took.”

The cost analysis also helped shape the president’s approach to intervention in foreign countries on a broader scale.

Rather than pursue lengthy and costly occupations — like Iraq and Afghanistan — which also led to wars of attrition with high casualties and resentment among some countries, Obama pursued a “lighter” approach that involved new technologies — such as drones and cyber warfare — and special forces operations.

The plan has been successful in limiting America’s involvement in foreign conflicts, Sanger said, but has also shown its weaknesses in the United State’s ability to intervene quickly in crises ranging from the conflict in Syria to the terrorist attack on the American consulate in Benghazi.